Capitol Region Offices Credit Card Transactions

*** Instructions for use***
Please print this page & refer to it during transaction.
Please complete all 7steps listed below:

STEP 1: Click on link below to access the web page.

STEP 2: Enter Login ID & Password in box in upper right called "Optional Logon."

STEP 3: Enter amount of credit card charge under "Donation Information."

STEP 4: Enter credit card information under "Payment Information." Include card number, type of card (MasterCard, Visa, Amex), exact month/year of expiration (example 02/2004), and cardholder's name as it appears on the card. You also must include the Card Security Code - it is the last 3 numbers typed in the signature box on the back of the card).

STEP 5: "Comments" Enter any comment about the transaction that would be useful for your accounting office -- for example, if the cardholder's name is different than client's name. *** If charge is for a Donation or Special Event, please provide full name & address of cardholder in this section and also what charge is for -- (Example, Ms. Mary Smith, 94 Main Street, Hartford, 01605 - Christmas Appeal Gift or Mr. Thomas Jones, 94 Main Street, Farmington, 16202 Golf Foursome). We will want to thank this person and include them in future mailings for newsletter, Annual Report, Christmas, Golf, as appropriate.

STEP 6: Go to "Please tell us how you heard about our site." Use the arrow to select the correct designation for this payment for accounting purposes (copay, adoption fees, donations, daycare fees, special events.)

STEP 7: Click on "Proceed to Verification" button.  If credit card is valid and information entered correctly, the screen will tell you the card was charged. If there are any errors, the screen will tell you the problem with the card or with the information entered.

ANY QUESTIONS?  Please contact Janet Romanowicz (email), Development Associate, at the Administrative Offices in Hartford at 860-728-2569 or your accounting office if you have any questions or experience any problems using this page.

Links to HIPAA Notice & form in English and Spanish are provided below if you need them.

Notice of Privacy Practices HIPAA

Aviso de procedimientos de privacidad HIPAA